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Posters • Peripheral Nerve Blocks 119

59. Infraclavicular block as preferrednaesthesiologic technique in therteriovenous fistulae placement

. Zampaglione1, M. Giardina1, A. Versaci1, D.C. Risitano1,

. Noto1, R. Messina1, F. Benedetto2, M. La Spada2,

. David1

A.O.U. Policlinico Messina, Anestesia e Rianimazione,essina, Italy, 2A.O.U. Policlinico Messina, Chirurgiaascolare, Messina, Italy

ackground and Aim: Durable vascular access for hemodialysisemains a critical issue in patients with renal failure. Creation ofutogenous Arterio-Venous Fistula (AVF) in the most distal loca-ion of the nondominant forearm, is the currently preffered tec-ique. The aim of this study was to show as regional blocks,hrough produced venodilatation and induced sensory-motorlock, can be useful for the creation of new AVF.

ethods: From February 2007 to March 2008, 37 patients (67/� 16 years) subjected to AVF placement, received infraclavicular

lock with levobupivacaine 0,5% (16 �/� 3,6 ml) or ropivacaine,75% ( 19 �/� 4 ml) using a nerve stimulator. Intraoperativeuplex ultrasonography was used to assess the degree of venodi-atation of the basilic and cephalic veins before and after the block.ach measurement was recorded in two times: before placement ofhe block, after placement of the block.

esults: Complete nerve block was achieved in 34 patients (91,8). In three cases an addictional dose of local anesthetic (lidocaine)

dmistered by the surgeon was necessary. A light sedation withemifentanil 0,05 �g/kg/min was provided in four patients. Sen-ory block was accomplished within 12 to 23 minutes withevobupivacaina 0,5%, while 9 to18 minutes with ropivacaina,75% and usually lasted 5 to 7 hours. Motor block was accom-lished in 13 to 24 minutes. No complications were recorded. Theegree of venodilatation noted as a percentage increase after place-ent of the block compared to the one before the placement of the

lock was 41% for the distal cephalic, 29% for the midcephalic and0% for the midbasilc veins.

onclusion: In our experience, infraclavicular block is a safe tech-ique that offers numerous advantages to the surgeon for AVFlacement and provides a good degree of analgesia to assure pa-ients comfort.

08. Ultrasound-guided combined lumbarlexus block and sciatic plexus block in aigh risk patient with alterated responseo nerve stimulation

. Ortiz de la Tabla Gonzalez, A. Martınez Navas,.L. Laguillo Cadenas, T. Vazquez Gutierrez,. Echevarrıa Morenoalme Hospital, Antesthesiology Department, Seville,pain

ackground and Aims: Combined lumbar plexus block and sci-tic plexus is an useful technique specially in high risk patientshen central blocks are contraindicated.1 Also, patients with dia-

etes mellitus present an atypical response to nerve stimulationecause neuropathys asociated.2 Actually we have the ultrasonog-aphy-guided periferic nerve blocks as an useful high success andecurity technique.3

ase Report: A 80-year-old, 60-kg male was scheduled for supra-ondyl amputation of his leg. His comorbidities included hyper-ension, hyperlipidemia, insulin-dependent diabetes mellitus,squemic cardiopathy with episodies of congestive heart failure,ronic obstructive pulmonar disease treated with oxigenotherapy atome and leg cronic isquemic. Forty days before, the patient was

reated by emergency surgical procedure because a medular com-ression of an arachnoid cyst after accidental remove of an epiduralatheter during anticoagulant treatment.The patient was placed inupine-position and a high-resolution ultrasound-probe placed atnguinal ligament was used to confirm the location of femoralerve. Then, patient was placed in Sim�s position and a convexltrasound-probe was placed on imagin line between greater tro-anter and isquiatic tuberosity and sciatic nerve was identified. Inoth cases, although realtime ultrasound images confirmed peri-eural location of the needle, motor response was observed at 2,3A stimulating current. 1,5% mepivacaine 20 ml was adminis-

ered around femoral nerve and another 20 ml around sciaticerve.Appropiate surgical anesthesia was established and the pro-edure was performed uneventfully.

onclusions: Combined lumbar plexus block and sciatic plexuslock is an useful technique in a high risk patient with contraindi-ations for central blocks. Also, ultrasound facilitated the accurateocalization of nerves in the patient with neuropathys associatedith diabetes mellitus and response to nerve stimulation.

. Ho AM et al. Can J Anaesth. 2002; 49: 946-50.

. Sites B et al. Reg Anesth Pain Med 2003;28:479-482.

. Marhofer P et al. Br J Anaesth 2005;94:7-17.